E-Cigarette Liquid Nicotine: Toxic, Unregulated and Overhyped

E-cigarettes are a hot topic this year. One minute they're public nuisances; the next they're helpful tools for quitting smoking. Other times they make users look like Boba Fett.

People just can't seem to agree on them.

The latest alleged danger is the liquid form of nicotine, called "e-liquid," which is used in both e-cigarettes and customizable mods. See a March New York Timesarticle called "Selling Poison by the Barrel: Liquid Nicotine for E-Cigarettes." The piece references several poison control calls from 2013 by parents whose kids had accidentally drunk the liquid.

The Food and Drug Administration (FDA) proposed its first set of rules toward regulating e-cigarettes and related products on Thursday. It's a standard first step that would prevent anyone under 18 from purchasing e-cigarettes and would also require manufacturers to disclose the products' ingredients and manufacturing processes to the FDA.

Still, there's a long way to go before the rules are put in place and take effect — federal officials and advocates say it will take at least another year — and most vaping enthusiasts argue that the fear over liquid nicotine is blown way out of proportion.

E-liquids, essentially, are nicotine concoctions sold in a variety of flavors: cherry, chocolate or cotton candy. They're used to refill e-cigarette mods or personal vaping devices. Most liquids are produced in factories and shipped to big stores throughout the country.

They're usually heavily diluted.

Until the FDA regulations go into effect, precautions like labeling and childproofing liquid containers are not required.

Dr. Ben Orozco, an associate medical director at the Hennepin Poison Center in Minneapolis, Minn., says the majority of the 74 e-cigarette and nicotine poisoning calls he received in 2013 were "exposure calls." (Picture a parent who comes home and finds his toddler near a bottle; he may call poison control as a precaution, even if he's unsure whether his child ingested the substance.)

"'Poisoning' for us is defined as any of our calls where there's exposure," says Orozco. "It doesn't necessarily mean ingestion."

A 2012 National Poison Data System (NPDS) report logged more than 100 exposure cases due to cigars, more than 1,000 due to chewing tobacco and more than 5,000 due to cigarettes. Comparatively, those due to liquid nicotine are drastically lower.

Still, Orozco says, the number of last year's liquid nicotine calls increased tenfold in Minnesota. Most poison centers across the country have seen similar figures, he says. It's mainly attributed to the new market — in 2012, for example, not many people used e-cigarettes or purchased liquid nicotine. But he's concerned it could lead to more severe poisoning cases down the road.

Most of the symptoms have been identical to other forms of nicotine poisoning — nausea, vomiting — which he's witnessed in cases where kids ate cigarettes or drank from the spit cups of chew tobacco users.

The main difference is texture, says Neal Benowitz, professor of medicine and bioengineering and therapeutic sciences at the University of California San Francisco. "When a child eats a cigarette, there's a lot of nicotine, but it's absorbed slowly," he says. "They usually vomit right away. But when you drink it from a can, depending on the potency, it absorbs quicker and can be much more dangerous.

"The amounts of nicotine in these bottles can be quite large," he says.

A sales associate fills an electronic cigarette with flavored E liquid at the Vapor Shark store on February 20, 2014 in Miami, Florida

Image: Joe Raedle

Several bigger e-cigarette stores in New York and other parts of the country label their bottles and include childproof caps. Smaller mom and pop shops tend to bypass labeling, though. Others concoct their own, stronger versions of e-liquids — part of the reason, some owners say, it's been getting such a bad reputation.

"It's a war on both sides," says Talia Eisenberg, 27, co-owner of the Henley Vaporium, an e-cigarette company in New York City. "It's a disparity between those selling pure nicotine — online or in these smaller shops — and those brands that are doing it responsibly. And because it's new, and sort of unknown in that regard, people have been quick to jump in and villainize them as a whole."

Last week, Henley launched an Indiegogo campaign to raise funds for iHenley, a Bluetooth-enabled device that tracks e-cigarette nicotine consumption through a smartphone app.

"It's important to know what you're putting into your body," she says. "Nobody's saying nicotine's healthy."

But children are curious, and accidents can happen, regardless where parents hide potentially dangerous substances. Few are storing liquid nicotine bottles next to the LEGO sets in their kids' playroom. But as evidenced by the hundreds of 911 and poison control center calls Orozco and others receive every year, kids have a way of getting into things they shouldn't.

David Rosen, head of the Life Sciences Industry Team at Foley and Lardner, worked as a regulatory council for the FDA from 1978 to 1992. He agrees that FDA regulation would solve a lot of debates around e-liquids, but like most people, he's not sure when we can expect those regulations to go into effect.

Thursday’s FDA proposals are only the beginning of a tiresome process. The agency will publish its suggested regulations, then allow the public and industry to weigh in. From there, they'll review the feedback and make tweaks before coming to a final ruling. All in all, says Rosen, it could take a year or more to complete.

"What it really comes down to is that we don't know if these products are manufactured under good conditions," he says. "Some shops offer bottles with labels and proper caps, but there are plenty of places online where you can buy unmarked e-liquids."

One of the biggest concerns is imported products. If and when the FDA regulates the liquids, Rosen guesses it would put a stop to all imports coming from outside the United States.

Whatever side people are on, Eisenberg says, it's a "wild, wild west." The overall consensus seems relatively universal: FDA regulations on e-cigarettes and e-liquids could help drastically. Progress has begun, but until proper and detailed regulations are fully in place, the best course of action is simple caution — from everyone.

"Nicotine has been around forever," Orozco says. "We know what it is and we know what it does. This is just a new form of that. It should be treated the same."

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